ADULT NURSING V (OBSTETRIC NURSING

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TALIPES

heels. . toes and feet . ‡ these incidences are known as congenital talipes equinov arus (CTEV) or clubfoot.OVERVIEW ‡ Talipes is a congenital deformity that develops in the womb during the first trimester (between 8 to 12 weeks) ‡ Causes an abnormal twisting of the ankles.

‡ Genetic or hereditary element ‡ Positioning of the foot when it is in the womb If there is too little amniotic fluid surrounding the baby in the womb (a condition called oligohydramnios).ETIOLOGY ‡ Cause is unknown. there is a higher rate of talipes. possibly due to increased pressure on the foot .

where the foot points inwards and up ‡ Talipes calcaneovalgus where the foot points inwards and down .the most common form ‡ Talipes equinovalgus .where the foot points outwards and down ‡ Talipes calcaneovarus .TYPES OF TALIPES ‡ Talipes equinovarus .

The foot is turned outwards and upwards. The heel is turned inwards and the whole foot plantar fiexed. ‡ . The affected foot is shorter and the calf muscles are thinner than normal.PATHOPHYSIOLOGY ‡ The pathophysiology of the more common isolated form is not known and is the subject of controversy . Possible contributing factors: too little amniotic fluid surrounding the baby un the womb ( a called oligohydramnios) increased pressure on the foot. The position of the foot is fixed and can't be easily corrected.

clubfoot may be secondary to paralysis. ‡ The foot turns inward and downward at birth (resisting realignment) ‡ The calf muscle may be smaller than normal and underdeveloped ‡ Clubfoot is painless. polio-myelitis.SIGNS & SYMPTOMS ‡ heel is turned inwards and the whole foot plantar flexed (bent downwards). except in elderly. or it may be only vaguely apparent. or cerebral palsy. arthritic patients. . in which case treatment must include management of the underlying disease ‡ Deformity may be so extreme that the toes touch the inside of the ankle. In older children.

and organs onto film.a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues. bones. ‡ x-ray . ‡ computerized tomography scan . and chemistry panel should also be done routinely.DIAGNOSTIC PROCEDURE ‡ An EKG and chest x-ray will identify the most common causes of clubbing ‡ A sedimentation rate.

‡ Plaster fixation The surgeon manipulates the foot into position. and holds it in place with plaster. and over the top of the knee. to hold the foot in a corrected position. up the sides of the leg. GOAL: to restore the feet to their normal position to enable proper function as well as eliminate pain and deformity. ‡ Strapping and physiotherapy Strips of adhesive strapping are passed around the foot.TREATMENTS ‡ Treatment is often started in the weeks following birth. ‡ Surgery aims to loosen and lengthen tightened ligaments and tendons in the medial and posterior parts of the feet .

. ‡The heel-cord is cut to complete the correction of the foot before the last cast is applied . followed by taping to maintain their improved position. ‡Then. by which time the heel-cord has healed properly SPLINTING CAST ‡The French method consists of gentle stretching of the feet.CONTS NON SURGICAL METHOD: ‡The Ponseti method begins with a series of gentle manipulations and toe-to-thigh cast placements for the first five to seven weeks . the last cast is placed for three weeks.

` Goal: A client can maintain of movement and can perform ADL normally. Nursing intervention: ` Assess the level of physical mobility R-to know the level of physical mobility of the client ` Assist the client to perform ADL R-to maintain the ADL .NURSING MANAGEMENT ` Nursing Diagnosis: Impaired physical mobility related to cast wear.

‡ Elevate the leg with pillow R-to reduce the pain and pressure at the leg ‡ Encourage client on bed rest R-to minimize the mobility and reduce anxiety E: pt free from pain .

CONTS ‡ Nursing diagnosis :Parent¶s knowledge deficit regarding condition. prognosis. selfcare and discharge needs ‡ Goal :Parent¶s will acknowledge feelings and identify health ways to deal with them Nursing intervention : ‡ 1) assess for the level of knowledge of parent¶s ‡ R:to know the level of knowledge to educate the parent¶s. . treatment.

‡ 2) review pathology.prognosis and future expectations ‡ R : provides knowledge base from which parents can make informed choices. ‡ 3) discuss the deformity and expected treatment in terms the parents can understands ‡ R : to rule out misconceptions and to provide accurate information about the deformity Evaluation : the pt was able to acknowledge feelings and identfy health ways to deal with them .

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